• Assess mucous membranes, number and consistency of stools, and frequency of vomiting. Assess for signs of infection (fever, chills, sore throat, cough, hoarseness, pain in lower back or side, difficult or painful urination). Assess for bleeding (bleeding gums; bruising; petechiae; and guaiac-test stools, urine, and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to venipuncture sites for 10 min. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension.
• Notify health care professional if symptoms of toxicity (stomatitis, uncontrollable vomiting, diarrhea, fever) occur; drug may need to be discontinued or dose decreased. Patients with severe diarrhea should be monitored carefully and given fluid and electrolyte replacement if they become dehydrated.
• Assess patient for hand-and-foot syndrome. Symptoms include numbness, dysesthesia or paresthesia, tingling, painless or painful swelling, erythema, desquamation, blistering, and severe pain.

Lab Test Considerations:

• Monitor hepatic (serum alkaline phosphatase, AST, ALT, and bilirubin), renal, and hematologic (hematocrit, hemoglobin, leukocyte, platelet count) function before and periodically during therapy. May cause leukopenia, anemia, and thrombocytopenia. Leukopenia may require discontinuation of therapy. Therapy should be interrupted if serum bilirubin ↑ to 1.5 times normal or greater; may be reinstituted after bilirubin returns to normal.
• Monitor PT or INR frequently in patients receiving warfarin and capecitabine to adjust warfarin dose. May cause ↑ bleeding within a few days of initiation of therapy to 1 mo following discontinuation of therapy. Risk is greater in patients over 60 yr.